Contemporary Management of Zygomaticomaxillary Complex Fractures

Abstract

Zygomaticomaxillary complex fracture is one of the most commonly treated facial fractures. Accurate reduction and stable fixation of the zygoma are required to restore facial symmetry and projection and avoid functional sequalae from changes in orbital volume. Achieving optimal outcome is challenging due to the complex three-dimensional anatomy and limited visualization of all affected articulations of the zygoma. This article provides an updated overview of the evaluation and management of zygomaticomaxillary complex fractures based on available evidence and clinical experience at our center. The importance of soft tissue management is emphasized, and approaches to internal orbital reconstruction are discussed. While evidence remain limited, intraoperative imaging and navigation may prove to be useful adjuncts in the treatment of zygomaticomaxillary fractures.

Evidence-Based Medicine for Midface/Orbit/Upper Facial Fracture Repair

“…Postoperative enophthalmos requiring surgical revision is a rare complication and is typically seen in scenarios with large orbital floor defects that were not adequately reconstructed or from the lateral displacement of the zygoma, leading to an increase in orbital volume. 30,35,36 Reduced malar projection is a complication reported in up to 84% of patients. 34…”

“…Major postoperative complications include palpable hardware, hardware infection, hematomas, ptosis, enophthalmos, cellulitis, corneal abrasion, persistent neurosensory disturbances, and persistent cheek asymmetry. 34,35 Patients who had a ZMC fracture complicated by an NOE fracture had more complications after surgical treatments than patients with isolated ZMC fractures. 35 One large study from 2013 describes 243 patients who underwent ZMC fracture repair and reports a revision rate of 1.6%, with the development of diplopia and enophthalmos being the main indication for repair.…”

“…34,35 Patients who had a ZMC fracture complicated by an NOE fracture had more complications after surgical treatments than patients with isolated ZMC fractures. 35 One large study from 2013 describes 243 patients who underwent ZMC fracture repair and reports a revision rate of 1.6%, with the development of diplopia and enophthalmos being the main indication for repair. 36 Secondary repair of ZMC fractures can require osteotomies, bone grafts, malar implants, alloplastic grafts, titanium implants, or fat grafting.…”

Impairment of the balance of angiogenic and neurogenic polypeptides of the oral fluid in fractures of the maxilla

“…Переломы верхней челюсти в области орбиты характеризуются такими особенностями, как близкое расположение жизненно важных анатомических структур, органа зрения, а также эстетической значимостью данной зоны лица и наличием рисков развития серьезных осложнений. Указанные обстоятельства формируют необходимость в высокой степени прецизионности работы хирурга, а также индивидуального подхода к лечению данных больных [6,7].…”

Vestibular versus trans-conjunctival approaches in open reduction and internal fixation of infraorbital rim fracture: A randomized clinical trial.

“…Even though during exposure of the facial skeleton, an alternative important concern is taken after to preserve the facial esthetics. Incisions are usually made in inconspicuous or hidden areas even this may compromise the bony exposure especially for the infraorbital rim region 1 . Thus, incision placement and design are guided by 2 goals: good intraoperative accessibility and minimal postoperative scar formation 2 .…”